Steps In Oxygen Transport Pathway

 (1-9)

1. FIO2(Fraction of Inspired O2) and airway.

*Room Air FIO2 about 21%

*Higher FIO2 worse the dz

2. Airways - w/o this O2 transport neg impacted

 3. Lung and Chest Wall Mechanics (distribution of ventilation) *muscle forces required for good ventilation

4. Diffusion/Transit Time (saturated w/in .25 secs)

 *How quickly does O2 and CO2 switch places to get O2 into the system

5. Perfusion (Blood Flow)

*Have to have bld flowing thru lungs to pick up the O2 or doesn't matter how much O2 your breathing in.

 6. Myocardial Function (good pump)

7. Peripheral Circulation (good bld vessels to deliver O2)

8. Tissue extraction and use of O2 - more mitochondria you have the more aerobic enzymes you have and better tissues are at pulling out O2 and using it.

 9. Return of CO2 and partially desaturated blood to lungs

If you don't have enough O2 being delivered you switch to _______________.

Anaerobic

Metabolism

4 Fundamental Processes

of the Resp System

1. Ventilation and distribution of gas volumes

2. Gas Exchange and transport

3. Bld circulation thru the lungs

4. Mechanical forces

- Resp  muscles

- Airflow resistance

Divisions of the

Resp System

*Air conducting division

- ventilatory pump

(ventilation means conducting air)

*Resp division

- Gas exchange (respiration)

Air conducting division

(Anatomy)

* Nasal Cavity

-Nasopharynx

- Oropharynx

- Larynx

-Trachea

-Bronchi

-Bronchioles

More than 10 ribs showing diaphragm

________________.

Fewer that 9 ribs are showing diaphragm

_______________.

*Lower and flatter than it should be

*Too high, than it should be

Air Conducting

Division

Fxns

*Air Conduction: from nose down to gas exchange unit.

*Air Conditioning:

- mucous cells add moisture

- air rapidly warmed to body temp

*Air Filtering

-mucous coat

- ciliary action

Resp

Division

(Anatomy)

*Resp bronchioles

- Alveolar ducts

- Alveolar sacs

- Alveoli

3 lobs on the right lung b/c

_____________.

R upper lobe __________.

R mid lobe ___________.

R lower lobe__________.

(no middle lobe posterior)

2 fissues

1. Hori Fissure - swings around hori around 4th rib

2. Oblique Fissure - swings around anteriorly to about 6 rib

*4th rib up to inch above clavical

*4th-6th rib b/n hori and oblique fissure

*Rib 6-8 (way lateral)

L lung only has _________.

L upper lobe ________.

L lower lobe ________.

-oblique fissure (same location only on L)

-rib 6 to inch above clavical

- underneath ribs 6-8

Parietal Pleura lines _________.

Visceral Pleura lines ________.

- lines the thorax

- lines lungs + diaphragm

*can get chest pain or sh + neck pain b/c of inflammed pleura

Bronchial Divisions:

(First 19 Generations)

* Trachea - not going to change size easiely b/c a lot of cartilage. (good thing) ends right at sternal angle (carina)

-Right and left mainstem bronchi

- Lobar bronchi

- Segmental bronchi

- subsegmental bronchi (5th - 7th generations) 

- bronchioles (8th-11th generations)

- terminal bronchioles (12th-16th generations)

- respiratory bronchioles (17th-19th generations)

Respiratory

Unit

(19th - 23th)

From Respiratory bronchioles

- Alveolar ducts: (19th-22nd generations)

- Alveolar sac: (23rd generation)

Aspirated food is

mostly in _______.

Right Lung

(goes down path more easily)

(right main stream bronchi more longtidunal - left more on angle.

Postural

Drainage

using gravity to help drain a segment

(to help move mucous a long)

Segmental bronchus and  the area of

lung that is goes to called _________.

Bronchal pulmonary segment - decreet

lung area that air is provided to that

segment via segmental bronchus.

Pt has excessive mucous in R lower bronchal pulmonary segment - using gravity use __________ to try to get

mucous moving up the lrger airway so they can cough it up.

Trendelenburg

Pt has excessive mucous in ant bronchal pulmonary segment in lower lobe on R position in ___________.

Supine

Pt has excessive mucous in post. bronchal pulmonary segment in lower lobe on R position in __________.

Excessive mucous on Lateral side of lung _________.

Excessive mucous on Medial side of lung_________.

*Prone

* L side-lying

*R side - lying

L lobe only has _________,

does not have _________.

Ant, Post, Lateral, and superior

*Medial

Pt has excessive mucous in upper portion

of lobe position pt in ________.

Sitting

Pt has excessive mucous in R middle lobe

position in __________.

Bed flat, sometimes slightly up or slightly

down.

Bronchial Changes: From Beyond

the 16th Generation.  There is ________.

There is no:

- cartilage (so they can change size a lot, which is good, you get good air velocity).

- mucous cells

- cilia (no mucous cells beyond cilia)

 There is an increase in:

-Elastic fibers - helps keeps airways open

- Smooth muscle cells- makes contract, helps keep airways open

                         (Alveolar are just little balloons)

Patients with disease pull in  more

__________ and _________

to help them breath.

If pt has obstuctive pulmonary dz, they will often __________.

* accessory muscles

*oxygen (even though they lack)

*lean on their hands, to stabilize the joint,  to elevate their ribs

Ext intercostals help _________.

With normal healthy people __________.

Pt's who have increased work of breathing ________.

*Elevate the ribs (work during exhalation)

*they are probably not using this m. at rest. You recuit the muscle with exercise.

*they will pull in their accessory  muscles all the time.

Internal intercostals help______.

However the internal intercostals right next to the sterum (parasternals) ____________.

*Help lower the ribs (work during exhalation)

*help elevate the costalcartilages and push the sternum out. (work during inhalation)

Pect minor takes origin into ________ and attracts into ______.

Major resp accessory muscle _________.

Scalenes used to be consider accessory muscle but not are consider __________.

*upper ribs, cortiod process

*sternalcloidmastoid (really kicks in in SC pts)

*prime mover, but we don't normally use them at rest.

Rectus abdominous and ext oblique help ________.

Importances of abdominals for inhalation __________.

*help pull rib cage down , important for full exhalation, also help when we cough, sneeze, preject your voice

* increased abdominal pressure helps diaphragm push ribs up and out as we breath in. (in SC pt's putting abd binder on, helps them breath better by increasing pressure on the abds)

The most important muscle of breathing is __________.

When it contracts, the _________.

If m. is low and flat ________.

*diaphragm

*the vertical fibers contract upward towards central tendon - this plus abd pressure, helps swing the ribs up and out.

*the vertical fibers are not as vertical and  doesn't move rib or even ribs can to go inward (notice with pts with long standing obstructive dz - can not change this)

*pump handle _________.

*bucket handle________.

*ant/post diameter

- upper rib movement

- primarily parasternals

*increase transverse diameter

-lower rib movement

-diaphragm and external intercostals

Neural Control of Ventilation

*pneumotaxic center __________.

*apneustic center__________.

*Inspiratory and Expiratory Cells __________.

*Vagal fibers - (Hering-Breuer reflexes)

 *Carotid and aortic chemoreceptors

*Carotid and aortic baroreceptors

* (in the pons) inhibits apneustic center.

*triggers us to breath in (pneumotaxic turns it off)

*(in medulla, work recipotcal w/ each other)

Vagal fiber- Hering-Breuer reflexes (also off switch mechanic)

As you start to breath in and the alveolar get stretched,  stretch receptors in the lungs begin to get send info to ___________.

As you exhale the stretch receptors info ________

*the vagus nerve which sends messages up to the brain stem to start to inhibit inspiration.

*to vagus nerve decreases, cause it's no longer being stretched

Chemical Control of Ventilation

*Central chemoreceptor (in brain stem) ______.

*peripheral chemoreceptors (in arch of aorta and cartiod sinus)

* stimulated by elevated PCO2 and low pH of bld and CSF. (signal to increase your breathing to blow of CO2)

*stimulated by low PO2 (trying to get your O2 up)

(if arterial PCO2 is normal, PO2 must drop, before ventiliation increases)

(increase PCO2 -  peripheral chemoreceptors will  response faster to decreasing PO2)

Sympathetic Input in resp - beta 2 receptors when stimulated cause __________.

Parasympathetic - cholinergic receptors cause ________.

-bronchodilation (we want pts to dilate their aiways)

-decreased bronchial secretions

-slight vasoconstriction

-bronchoconstriction (we don't want, may need anti-cholinergic)

-increased bronchial secretions

-indirect vasodilation

*Epinephrine, norepiphrine,angiotensin,and histamine ________________.

*decreased PO2 levels with cause __________.

*Bradykinin, acetylcholine, aminophylline, and isoproterenol _______________

*will cause vasoconstriction in the pulmonary vessels

*will cause vasoconstriction in the pulmonary vessels, but vasodilation in the peripheral vessels.

*will cause cause vasodilation in pulmonary and peripheral vessels

Pulmonary Mechanics - what are the resp m. forces

 (Elastic Behavior)

-Compliance ___________________.

 -lung vs chest ________________.

 -sucfactant _____________.

- change in vol/change in pressure (how much vol increase will I get in the lungs giving the amt of pressure worked.)

-lungs like to go in and chest likes to go out which creates a neg pleura pressure(should be neg)

(the more I breath in the more I have to overcome elasticity of the lungs, more I breath out the more I have to outcome elastic of the chest)

(phosolipid that is produced by the alveolar cells)

-decrease alveolar surface tension, which decreases  alveolar collapsibilty

-increase alveolar compliance, which decreases work of breathing

Pulmonary Mechanics - what are the resp m. forces

 (Non elastic behavior)

*airflow resistance __________.

*tissue resistance

*inertial forces

primarily is air flow resistance.

 *most occurs in lrger airways, cause more volume.

*or is pt has a lot of mucous or broncho spasm.

(however b/c of cartilage you can't get much change in diameter in lrger airways)

Chest and lungs are equal in

_______________.

(ventilatory muscles are also at pretty good tension relationship)

functional

residual

capacity

( what's left in lungs, can blow out more, but we usually don't)

Obstructive dz they have more trouble getting _______________

Restrictive dz they have more trouble getting ______________.

*air out cause they have an obstruction and lungs have lost elasticity cause they are too compliance

*air in cause something's not letting them move, even lungs can't expand or the chest can't expand

Deep breath 2 to 3 seconds allows for 

_______________.

collateral ventilation

 b/n bronchials.

Pretty much ever pt who's had sx, has some degree of lung collapse cause we breath  more swallow _______________.

Pleura pressure decreases with ____________.

Pleura pressure increases with _________________.

inspiration (becomes more neg)

expiration (becomes less neg)

Alveolar pressure breath

in_______________.

Alveolar pressure breath out _______________.

*negative

*positive

Pulmonary carries venous blood ____________.

Bronchal carries arterial blood ________________.

*supplies gas exchange division

*supplies the air-conducting division

Pulmonary Lymphatics

(3rd circulatory systems in the lungs)

*Control fluid balance w/in lung parenchyma

*Arise w/in the pleurae, not w/in the alveolar capillary space.

*Rise and fall of pleural pressure during respiration compresses lymphatic vessels - continous flow of lymph